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Montana rates for HCPCS Q4156

Neox 100 or Clarix 100, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.54 / $71.81 / $76.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.91 / $73.91 / $73.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $73.91 / $73.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.88 / $73.91 / $82.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.23 / $71.47 / $93.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $65.88 / $65.88